News Scan for Mar 02, 2016

Study: Effectiveness of favipiravir for Ebola inconclusive

Members of the JIKI Study Group reported inconclusive and varied results for use of the antiviral medication favipiravir to treat Ebola virus disease, according to a study yesterday in PLOS Medicine.

The JIKI ("hope" in the Malinke language) study was a multicenter, nonrandomized trial in which 126 Ebola patients in Guinea received favipiravir and standard care. Because of the perception that randomizing patients to case and control groups was unethical in the situation, data from 99 of the cases were compared with data from historical controls.

Investigators found that administration of favipiravir was ineffective in patients with very high viremia (ie, baseline cycle threshold [Ct] value of less than 20). Among 44 subjects with very high viremia who received favipiravir, the mortality rate was 91% (95% confidence interval [CI], 78.8%–91.1%). The mortality rate for people with very high viremia and high baseline creatinine levels (110 mcmol/L or more) was 97%.

Among 55 subjects with moderate to high viremia (ie, baseline Ct 20 or greater), the mortality rate was 20% (95% CI, 11.6%-32.4%). Among those in this group who had high baseline creatinine levels, the mortality rate was 17%.

Treatment start time did not appear to affect mortality or viral load.

The investigators said they were unable to determine the safety or effectiveness of favipiravir, given the inconclusive results of this study and the lack of randomized case and control groups. They recommended that further study on the effectiveness of favipiravir in cases of moderate to high Ebola viremia is warranted.Mar 1 PLOS Medicinestudy

Nigeria hit by 7 more avian flu outbreaks

H5N1 avian influenza struck seven more sites in Nigeria in late February, extending a string of outbreaks that began last September, according to a report the government filed with the World Organization for Animal Health (OIE) Feb 29.

The latest outbreaks, which began between Feb 20 and 27, hit six farms and one backyard flock. Most of the operations produced layer chickens, but one raised pullets and one listed "poultry" of mixed ages. The sites were scattered among three provinces (Kano, 3; Kaduna, 1; and Plateau, 2) and the Federal Capital Territory, all in the north-central and central parts of the country.

The disease killed 2,071 of 14,170 birds at the seven locations, and the rest were destroyed to prevent further outbreaks, according to the OIE report. The source of the virus was unknown, but like other recent Nigerian reports, this one cited "poor farm biosecurity" as a contributing factor.

Nigeria is the hardest-hit of several African countries that have suffered a resurgence of H5N1 outbreaks in the past year. Feb 29 OIE report

WHO says polio transmission remains public health emergency

The World Health Organization (WHO) announced yesterday that polio, declared a Public Health Emergency of International Concern (PHEIC) in May 2014, will remain so following presentations at a Feb 12 meeting of the International Health Regulations (IHR) emergency committee.

Factors contributing to the decision include regional weaknesses in immunization coverage leading to circulating vaccine-derived polioviruses (cVDPV), civil unrest or insecurity, displacement of refugees and other mobile populations, and cross-border polio transmission.

Six outbreaks of cVDPV occurred in 2015, three of which—in Myanmar, Nigeria, and Guinea—involved type 2 poliovirus, which will be withdrawn from oral vaccine next month, necessitating urgent action to stop circulation of this type. The other cVDPV outbreaks, involving type 1 poliovirus, occurred in Ukraine, Madagascar, and Laos.

While coordinated efforts in Pakistan and Afghanistan, the only countries where polio remains endemic, have led to a decline in wild poliovirus transmission, cross-border poliovirus spread is still occurring between them.

he IHR committee recommended that countries in which wild or vaccine-derived poliovirus transmission is occurring should require and document vaccination before travelers leave and should coordinate cross-border vaccination efforts with neighboring countries. They further recommended that countries vulnerable to transmission due to population mobility or inadequate immunization coverage institute routine polio immunization, increase surveillance, vaccinate mobile populations, and focus on cross-border immunization coverage.

The WHO's temporary recommendations became effective Feb 26 and will be in place for the next 3 months.March 1 WHO statement Dec 2, 2015, CIDRAP News scan on previous IHR meeting